脑梗死患者与健康体检者颅外段脑动脉血管结构和血流动力学变化的差异

背景颈动脉粥样硬化患者中脑梗死发生率较高,但缺少大样本的研究,尤其缺少血流动力学变化的研究.目的研究脑梗死患者颅外段脑动脉血管结构和血流动力学变化特点,并与健康人进行差异比较.设计以诊断为依据,病例对照研究.地点和对象1999-01/2002-05中国铁道建筑总公司总医院住院患者300例(脑梗死组),其中男242例,女58例.2000-02/2001-10在本院体检健康者105例(健康组),男50例,女55例.主要观察指标血管内径及颈总动脉内壁(内膜与中膜之和);血流参数测定收缩期最大血流速度(Vmax)、舒张期最小血流速度(Vmin)、血管阻力指数(RI)、收缩期颈内动脉血流速度与颈总动脉血流速度的比值(VICA/VCCA).结果脑梗死患者梗死侧血管粥样硬化斑发生率(55.8%)明显高于非梗死侧(46.3%),差异有显著性意义(x2=4.487,P＜0.05),侧向符合率高;其血流参数的改变以Vmin,VICA/VCCA及RI最为明显,差异均有高度显著性意义(P＜0.01～0.001).结论脑梗死患者梗死侧血管粥样硬化斑的发生率明显高于非梗死侧,侧向符合率高;血流参数的改变以MIN明显减慢、RI明显增高为主要特点.

Differences of extracranial artery structure and hemodynamic changes between normal people and patients with cerebral infarction

BACKGROUND:The incidence of cerebral infarction is high in patients suffering from carotid atherosclerosis. But study about it with large samples is rare, especially that about the hemodynamic changes.OBJECTIVE: To study the characteristics of extracranial artery structure and hemodynamicchanges in patients with cerebral infarction and make a comparison of these with those of the normal people.DESIGN:A case control study based on diagnosis.SETTING and PARTICIPANTS: In cerebral infarction group, there were 300 patients(male 242, female 58) who were hospitalized in the General Hospital of China Railway Construction Corporation from January 1999 to May 2002. In normal control group, there were 105 healthy people (male50,female 55) who received routine health examination in the hospital from February 2000 to October 2001.MAIN OUTCOME MEASURES: The artery diameter and the inner layer (combination of tunica intima and tunica media) of common carotid artery. Hemodynamic parameters: The maximal systolic blood flow velocity (Vmax),the minimal diastolic blood flow velocity(Vmin), artery resistance index(RI), the ratio of systolic velocity of internal carotid artery to systolic velocity of common carotid artery (VICA/VCCA).RESULTS: The incidence of atherosclerosis plaque in the artery ipsilateral to the infarction (55.8%) was higher than that(46.3% ) in the artery contralateral to the infarction(55.8% ) ( x2 =4.487, P< 0. 05 ) . The side conincidence rate was high. Changes of Vmin, VICA/VCCA and RI were obvious, and of significant decisive difference( P< 0.01 -0. 001 ).CONCLUSION: The incidence of atherosclerosis plaque in artery ipsilateral to infarction is higher than that in contralateral artery and with high side coincidence rate. Decrease of Vmin and increase of RI feature the changes of the hemodynamic parameters.